Your browser does not support javascript. This is required for using the requested form.
CORPORATE AND CHARITABLE GIFT CARD PROGRAM CUSTOMER SET UP/CHANGE REQUEST
Legal name of business
*
Contact Name
*
Title
*
Address 1:
*
Address 2:
Suite #:
City:
*
Province/State:
*
Postal Code/Zip:
*
Country
Phone Number (with area code)
*
Fax Number (with area code)
E-mail
*
GST/HST Number
*
Dun & Bradstreet No.
Charitable Orgn' # (if applicable)
Payment Method:
Certified Cheque (payable to Shoppers Drug Mart)
EFT
Credit Card
Email
*
Bank ID
*
Bank Transit
*
Bank Account
*
Credit Card Type
*
Visa
Mastercard
Do you need to supply an alternate vendor location for ordering or shipping?
No
Yes
Location Type:
*
Location Name:
*
Street Address:
*
Suite #:
City:
*
Province/State:
*
Postal Code/Zip:
*
Country
Phone Number (with area code)
*
Fax Number (with area code)
If order will be less than $5,000, please complete the information below in order to avoid shipping and handling fees of $30/order.
Shipping A/C Number
Shipper (e.g.UPS)
Approved by:
Date:
Approved by:
Date:
Entered by:
Date:
Verified by:
Date:
*
=
Input is required